Despite N55.44 billion in disbursements to states' primary healthcare centres between 2022 and the first half of 2025, Nigeria's primary healthcare system remains under severe strain. Experts warn that thousands of Nigerians continue to face avoidable health risks because these facilities lack personnel, infrastructure and basic resources needed to provide care.
Concerns persist even as Nigeria's health budget rose by about 60 per cent and the Basic Health Care Provision Fund (BHCPF) is projected to reach N298 billion by the end of 2026. However, stakeholders say these allocations may not automatically translate into stronger primary healthcare delivery because delayed releases, weak accountability mechanisms and uneven spending priorities across states continue to undermine impact.
Funding Trends
Data obtained exclusively by The Guardian showed that total disbursements to states under the BHCPF through the National Primary Health Care Development Agency (NPHCDA) gateway between 2019 and the first half of 2025 stood at about N82.69 billion. A breakdown showed a steady upward trend: N13.5 billion was disbursed between 2019 and 2020, N13.7 billion in 2021, N19.87 billion in the 2022/2023 cycle, N21.5 billion in 2024, and N14 billion in the first two quarters of 2025. Cumulative disbursements from 2022 to the first half of 2025 stood at N55.44 billion.
Kano and Katsina were among the states with the highest cumulative allocations. Kano received about N4.70 billion, while Abia and Anambra received about N2 billion and N2.9 billion, respectively.
Survey Reveals Grim Picture
A 2025 Primary Health Care Systems Survey by BudgIT assessed 5,099 primary healthcare facilities across all 36 states and the Federal Capital Territory. The report found that 85 per cent of facilities had no doctor or physician, 61 per cent had no nurse or midwife, 38 per cent lacked access to water, 40 per cent had no functional laboratory, and only 51 per cent had electricity.
Electricity coverage was especially poor in some states. In Zamfara, only 31.7 per cent of facilities had electricity, while Borno recorded 36.2 per cent. In Ebonyi, only 42 of the state's 147 primary healthcare centres were electrified.
At the national level, 30,236 medical personnel served the 5,099 facilities surveyed, averaging 5.93 health workers per facility. However, doctors accounted for only 1,322 personnel, or 4.37 per cent of the total workforce. Nurses and midwives numbered 10,810 (35.75 per cent), while community health extension workers stood at 18,103 (59.88 per cent).
The report highlighted severe shortages in several states. Benue had only three doctors across 111 facilities, Bauchi had five doctors across 159 facilities, and Kogi had seven doctors across 179 facilities. In the Federal Capital Territory, only three doctors served 58 primary healthcare facilities.
NPHCDA Response
Dr Muyi Aina, Executive Director and Chief Executive Officer of the NPHCDA, explained that about 85 per cent of BHCPF funds go directly to facilities for service delivery. He noted that accountability mechanisms had been strengthened through quarterly verification visits and digital tools, recovering about N59 million in mismanaged funds over the past year.
Aina said utilisation of PHC services increased from about 29 million per quarter in mid-2023 to over 46 million per quarter in the third quarter of 2025. However, he acknowledged that funding remains insufficient due to decades of chronic underinvestment.
Stakeholder Reactions
Dr Jerome Mafeni, Technical Director of the Network for Health Equity and Development, argued that the larger problem lies in how resources are utilised. He said the current centralised governance structure does not promote efficiency, and called for decentralisation to give local facilities flexibility to determine priorities.
Ms Omei Bongos-Ikwue, Public Health Practice Lead at Gatefield, stressed that states' prioritisation of health in their budgets is crucial. She cited Bauchi State, which devoted nearly 15 per cent of its budget to health despite low resources per capita. She called for performance-based grants and stronger human resources at local government levels.
Experts maintained that until governance bottlenecks are addressed, persistent shortages of health workers, essential commodities, infrastructure and basic services are likely to continue despite billions of naira committed to the sector.
